When humoral medicine gave way to more scientific approaches in the nineteenth century, the physician’s gaze changed. Amongst the epistemological transformations were representations and perceptions of the poor patient: the pauvre malade—a pauper who happened to be sick and was to be taken care of by traditional medical charities—became a malade pauvre, a sick person who happened to be poor and was to be treated in new institutions. This article explores these changes but in settings beyond the clinic. In three case studies, we explore the practice of the Genevan physician Louis Odier, the management of the poor in the French spa of Saint-Amand and, finally, treatises about British spas. The agency of physicians, administrators and the poor themselves are analysed. Physicians played an ambiguous role. Some resisted innovation and refused to consider the poor as suffering from the same diseases as the affluent; others made opportunistic use of case histories, including those of the poor, to convince richer patients of the benefits of specific treatments, thereby reinforcing ‘class-blind’ ontological conceptions of disease. Administrators, for their part, tended to see the poor foremost as patients and put pressure on physicians to arrive at precise diagnoses.

中文翻译：

---

重新思考病人：十八世纪医学背景下的穷人病和穷人病

十九世纪，当体液医学让位于更科学的方法时，医生的目光发生了变化。认识论的转变包括对贫困病人的表征和看法：“pauvre malade”——一个碰巧生病并由传统医疗慈善机构照顾的穷人——变成了“malade pauvre”，一个碰巧贫穷且需要照顾的病人。将在新的机构接受治疗。本文探讨了这些变化，但是在诊所以外的环境中进行的。在三个案例研究中，我们探讨了日内瓦医生路易斯·奥迪尔的实践、法国圣阿芒温泉中穷人的管理，最后探讨了有关英国温泉的论文。对医生、行政人员和穷人本身的作用进行了分析。医生扮演了一个模糊的角色。有些人抵制创新，拒绝认为穷人与富人患有同样的疾病；其他人则机会主义地利用病史，包括穷人的病史，让富裕的患者相信特定治疗的好处，从而强化了疾病的“阶级盲”本体论概念。就管理人员而言，他们倾向于将穷人首先视为患者，并向医生施加压力，要求他们做出准确的诊断。